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NPI Code Detail

MEDICARE: MARK S BUDDELMEYER LICDC, LPC

MEDICARE: MARK S BUDDELMEYER LICDC, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorC.1300423OH
2175T00000XPeer Specialist136OH
3101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1588168041
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK S BUDDELMEYER LICDC, LPC
Provider Business Mailing Address
First Line : 2065 STONERIDGE DR
Second Line :
City : CIRCLEVILLE
State : OH
Zip : 43113-8956
Country : US
Telephone Number : 740-500-1391
Fax Number : 740-500-1395
Provider Business Practice Location Address
First Line : 1875 STONERIDGE DR
Second Line :
City : CIRCLEVILLE
State : OH
Zip : 43113-8956
Country : US
Telephone Number : 740-500-1391
Fax Number : 740-500-1395
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2018
Last Update Date : 03/01/2023

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